Healthcare Provider Details

I. General information

NPI: 1073511622
Provider Name (Legal Business Name): GREG GULBRANSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 SOUTH ST
OYSTER BAY NY
11771-2910
US

IV. Provider business mailing address

229 SOUTH ST
OYSTER BAY NY
11771-2910
US

V. Phone/Fax

Practice location:
  • Phone: 516-922-3131
  • Fax: 516-922-5218
Mailing address:
  • Phone: 516-922-3131
  • Fax: 516-922-5218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number205715-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: